Agency Information Collection Activities: Proposed Request and Comment Request, 40121-40124 [2019-17281]
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40121
Federal Register / Vol. 84, No. 156 / Tuesday, August 13, 2019 / Notices
(Catalog of Federal Domestic Assistance
Number 59008)
Rafaela Monchek,
Acting Associate Administrator for Disaster
Assistance.
[FR Doc. 2019–17275 Filed 8–12–19; 8:45 am]
BILLING CODE 8026–03–P
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA–2019–0034]
Agency Information Collection
Activities: Proposed Request and
Comment Request
The Social Security Administration
(SSA) publishes a list of information
collection packages requiring clearance
by the Office of Management and
Budget (OMB) in compliance with
Public Law 104–13, the Paperwork
Reduction Act of 1995, effective October
1, 1995. This notice includes one new,
one extension, and revisions of OMBapproved information collections.
SSA is soliciting comments on the
accuracy of the agency’s burden
estimate; the need for the information;
its practical utility; ways to enhance its
quality, utility, and clarity; and ways to
minimize burden on respondents,
including the use of automated
collection techniques or other forms of
information technology. Mail, email, or
fax your comments and
recommendations on the information
collection(s) to the OMB Desk Officer
and SSA Reports Clearance Officer at
the following addresses or fax numbers.
(OMB) Office of Management and
Budget, Attn: Desk Officer for SSA,
Fax: 202–395–6974, Email address:
OIRA_Submission@omb.eop.gov.
(SSA) Social Security Administration,
OLCA, Attn: Reports Clearance
Director, 3100 West High Rise, 6401
Security Blvd., Baltimore, MD 21235,
Fax: 410–966–2830, Email address:
OR.Reports.Clearance@ssa.gov.
Or you may submit your comments
online through www.regulations.gov,
referencing Docket ID Number [SSA–
2019–0034].
I. The information collection below is
pending at SSA. SSA will submit it to
OMB within 60 days from the date of
this notice. To be sure we consider your
comments, we must receive them no
later than October 15, 2019. Individuals
can obtain copies of the collection
instruments by writing to the above
email address.
Advance Representative Payee
Representative Payee Supporting
Statement for Advance Designation of
Representative Payee—0960–NEW. On
April 13, 2018, the President signed into
law The Strengthening Protections for
Social Security Beneficiaries Act of
2018, also known as Public Law 115–
165. Section 201 of the law allows SSA
beneficiaries and applicants under Title
II, Title VIII and Title XVI, of the Social
Number of
responses
jspears on DSK3GMQ082PROD with NOTICES
Modality of completion
Secuirty Act (Act) to designate
individuals to serve as a representative
payee should the need arise in the
future. Section 201(j)(2) of the Act
provides the requirements for selecting
a qualified representative payee. SSA
only offers the option to advance
designate to capable adults and
emancipated minors. Beneficiaries who
have an assigned representative payee,
or have a representative application in
process, cannot advance designate.
Form SSA–4547, Advance Designation
of Representative Payee, allows
beneficiaries or applicants the option to
designate individuals in order of
priority, to serve as a representative.
Beneficiaries or applicants can update
or change the advance designee order of
priority at any time. SSA uses the
information on Form SSA–4547 to
select a qualified representative payee
in order of priority. If the selected
representative payee is unable or
unwilling to serve, or meet SSA
requirements, SSA will select another
representative payee to serve in the
beneficiaries and applicants best
interest. SSA will notify beneficiaries
annually of the individuals they chose
in advance to be their representative
payee. The respondents are SSA
beneficiaries and claimants who want to
choose an advance designate
representative.
Type of Request: Request for a new
information collection.
Frequency of
response
Total
estimated
total annual
burden
(hours)
Average
burden per
response
(minutes)
SSA–4547—Paper Version .............................................................................
SSA–4547—Intranet version (SSI Claims System; MCS; iMAIN) ..................
i4547—Internet version ....................................................................................
85,733
8,451,966
3,201,466
1
1
1
6
6
6
8,573
845,197
320,147
Totals ........................................................................................................
11,739,165
........................
........................
1,173,917
II. SSA submitted the information
collections below to OMB for clearance.
Your comments regarding these
information collections would be most
useful if OMB and SSA receive them 30
days from the date of this publication.
To be sure we consider your comments,
we must receive them no later than
September 12, 2019. Individuals can
obtain copies of the OMB clearance
packages by writing to
OR.Reports.Clearance@ssa.gov.
1. Report to United States Social
Security Administration by Person
Receiving Benefits for a Child or for an
Adult Unable to Handle Funds/Report
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to the United States Social Security
Administration—0960–0049. Section
203(c) of the Act requires the
Commissioner of SSA to make benefit
deductions, and provides for the
Commissioner to impose penalty
deductions on benefits of individuals
who fail to make timely reports of
events, which are cause for deductions.
SSA uses Forms SSA–7161–OCR–SM
and SSA–7162–OCR–SM to: (1)
Determine continuing entitlement to
Social Security benefits; (2) correct
benefit amounts for beneficiaries
outside the United States; and (3)
monitor the performance of
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representative payees outside the
United States. This collection is
mandatory as an annual (or every other
year, depending on the country of
residence) review for fraud prevention.
In addition, the results can affect
benefits by increasing or decreasing
payment amount or by causing SSA to
suspend or terminate benefits. The
respondents are individuals living
outside the United States who are
receiving benefits on their own (or on
behalf of someone else) under Title II of
the Act.
Type of Request: Revision of an OMBapproved information collection.
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Federal Register / Vol. 84, No. 156 / Tuesday, August 13, 2019 / Notices
Number of
respondents
Modality of completion
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–7161–OCR–SM ......................................................................................
SSA–7162–OCR–SM ......................................................................................
42,314
426,448
1
1
15
5
10,579
35,537
Totals ........................................................................................................
468,762
........................
........................
46,116
2. Waiver of Your Right to Personal
Appearance before an Administrative
Law Judge—20 CFR 404.948(b)(l)(i) and
416.1448(b)(l)(i)—0960–0284.
Applicants for Social Security, Old Age,
Survivors and Disability Insurance
(OASDI) benefits and Supplemental
Security Income (SSI) payments have
the statutory right to appear in person,
or through a representative, and present
evidence about their claims at a hearing
before an administrative law judge
(ALJ). If claimants wish to waive this
right to appear before an ALJ, they must
do so in writing. Form HA–4608 serves
as a written waiver for the claimant’s
right to a personal appearance before an
ALJ. The ALJ uses the information we
collect on Form HA–4608 to continue
processing the case, and makes the
completed form a part of the
documentary evidence of record by
placing it in the official record of the
proceedings as an exhibit. Respondents
are applicants or claimants for OASDI
and SSI, or their representatives, who
request to waive their right to appear in
person before an ALJ.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
HA–4608 ..........................................................................................................
12,000
1
2
400
3. Request for Social Security
Statement—20 CFR 404.810—0960–
0466. Section 205(c)(2)(A) of the Act
requires the Commissioner of SSA to
establish and maintain records of wages
paid to, and amounts of selfemployment income derived by, each
individual as well as the periods in
which such wages were paid and such
income derived. An individual may
complete and mail Form SSA–7004 to
SSA to obtain a Statement of Earnings
or Quarters of Coverage. SSA uses the
information Form SSA–7004 collects to
identify respondent’s Social Security
earnings records; extract posted
earnings information; calculate potential
benefit estimates; produce the resulting
Social Security statements; and mail
them to the requesters. The respondents
are Social Security number holders
requesting information about their
Social Security earnings records and
estimates of their potential benefits.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–7004 ........................................................................................................
60,026
1
5
5,002
4. Function Report—Child (Birth to
1st Birthday, Age 1 to 3rd Birthday, Age
3 to 6th Birthday, Age 6 to 12th
Birthday, Age 12 to 18th Birthday)—20
CFR 416.912 and 416.924a(a)(2)—0960–
0542. As part of SSA’s disability
determination process, we use Forms
SSA–3375–BK through SSA–3379–BK
to request information from a child’s
parent or guardian for children applying
for SSI. The five different versions of the
form contain questions about the child’s
jspears on DSK3GMQ082PROD with NOTICES
Frequency of
response
day-to-day functioning appropriate to a
particular age group; thus, respondents
use only one version of the form for
each child. The adjudicative team
(disability examiners and medical or
psychological consultants) of State
disability determination services offices
collect the information on the
appropriate version of this form (in
conjunction with medical and other
evidence) to form a complete picture of
the children’s ability to function and
their impairment-related limitations.
The adjudicative team uses the
completed profile to determine: (1) If
each child’s impairment(s) results in
marked and severe functional
limitations; and (2) whether each child
is disabled. The respondents are parents
and guardians of child applicants for
SSI.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
SSA–3375; SSA-3376; SSA-3377; SSA-3378; SSA–3379 .............................
579,000
1
20
193,000
5. Private Printing and Modification of Forms—20 CFR 422.527—0960–0663.
Prescribed Application and Other
20 CFR 422.527 of the Code of Federal
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Regulations requires a person,
institution, or organization (third-party
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entities) to obtain approval from SSA
prior to reproducing, duplicating, or
privately printing any application or
other form the agency owns. To obtain
SSA’s approval, entities must make
their requests in writing using their
company letterhead, providing the
required information set forth in the
regulation. SSA uses the information to:
(1) Ensure requests comply with the law
and regulations, and (2) process requests
from third-party entities who want to
reproduce, duplicate, or privately print
any SSA application or other SSA form.
SSA employees review the requests and
provide approval via email or mail to
the third-party entities. The respondents
are third-party entities who submit a
request to SSA to reproduce, duplicate,
or privately print an SSA-owned form.
Regulation section
Number of
respondents
Frequency of
response
Number of
responses
Average
burden per
response
(minutes)
Estimated total
annual burden
(hours)
20 CFR 422.527 ..................................................................
10
15
150
10
25
6. Letter to Custodian of Birth
Records/Letter to Custodian of School
Records—20 CFR 404.704, 404.716,
416.802, and 422.107—0960–0693.
When individuals need help in
obtaining evidence of their age in
connection with Social Security number
(SSN) card applications and claims for
benefits, SSA can prepare the SSA–
L106, Letter to Custodian of School
Records, or SSA–L706, Letter to
Custodian of Birth Records. SSA uses
the SSA–L706 to determine the
existence of primary evidence of age for
SSN applicants. SSA uses both letters to
verify with the issuing entity, when
necessary, the authenticity of the record
submitted by the SSN applicant or
claimant. The respondents are schools,
State and local bureaus of vital
statistics, and religious entities.
Type of Request: Revision of an OMBapproved information collection.
Number of
respondents
Modality of completion
Frequency of
response
Average
burden per
response
(minutes)
Estimated
total annual
burden
(hours)
SSA–L106—Private Sector .............................................................................
SSA–L106—State/Local/Tribal Government ...................................................
SSA–L706—Private Sector .............................................................................
SSA–L706—State/Local/Tribal Government ...................................................
18
14
429
426
1
1
1
1
10
10
10
10
3
2
72
71
Totals ........................................................................................................
887
........................
........................
148
7. Application Status—20 CFR
401.45—0960–0763. Application Status
provides users with the capability to
check the status of their pending Social
Security claims via the National 800
Number Automated Telephone Service.
Users need their SSN and a
confirmation number to access this
information. SSA systems determine the
jspears on DSK3GMQ082PROD with NOTICES
This is a correction notice. SSA
published this information collection as
a revision on June 4, 2019 at 84 FR
25891. Since we are not making any
revisions to this collection, this is now
an extension of an OMB-approved
information collection.
Type of Request: Extension of an
OMB-approved information collection.
type of claim(s) the caller filed based
upon the information provided.
Subsequently, the automated telephone
system provides callers with the option
to choose the claim for which they wish
to obtain status. If the caller applied for
multiple claims, the automated system
allows the caller to select only one
claim at a time. Once callers select the
claim(s) they are calling about, an
automated voice advises them of the
status of their claim. The respondents
are current Social Security claimants
who wish to check on the status of their
claims.
Type of Request: Revision of an OMBapproved information collection.
Modality of completion
Number of
respondents
Frequency of
response
Average
burden per
response
(minutes)
Estimated
total annual
burden
(hours)
Application Status—Automated Telephone System ........................................
248,485
1
3
12,424
8. Government-to-Government
Services Online Website Registration
Form; Government-to-Government
Services Online Website Account
Modification/Deletion Form—20 CFR
401.45—0960–0757. The Governmentto-Government Services Online (GSO)
website allows various external
organizations to submit files to a variety
of SSA systems and, in some cases,
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17:51 Aug 12, 2019
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receive files in return. The SSA systems
that process data transferred via GSO
include, but are not limited to, systems
responsible for disability processing and
benefit determination or termination.
SSA uses the information on Form
SSA–159, Government-to-Government
Online website Registration Form, to
register the requestor to use the GSO
website. Once we receive the SSA–159,
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SSA provides the user with account
information and conducts a
walkthrough of the GSO website as
necessary. Established organizations
may submit Form SSA–159 to register
additional users as well. The established
requesting organizations can also
complete Form SSA–160, Governmentto-Government Online website Account
Modification/Deletion Form, to modify
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their online accounts (e.g., address
change). Respondents are State and
local government agencies, and some
private sector business entities.
Number of
respondents
Modality of completion
Frequency of
response
Average
burden per
response
(minutes)
Estimated
total annual
burden
(hours)
SSA–159 ..........................................................................................................
SSA–160 ..........................................................................................................
1,151
410
1
1
15
15
288
103
Totals ........................................................................................................
1,561
........................
........................
391
9. Evidence From Excluded Medical
Sources of Evidence—20 CFR 404.1503b
and 416.903b—0960–0803. Pursuant to
its broad authority to regulate under
sections 205(a), 702(a)(5), and
1631(d)(1) of the Act, SSA implemented
section 223(d)(5)(C), as amended,
through regulations at 20 CFR
404.1503b and 416.903b. These
regulations require excluded medical
sources to self-report their excluded
status in writing each time they submit
evidence related to a claim for benefits
under Titles II or XVI of the Act.
Excluded medical sources’ duty to selfreport their excluded status apply to
evidence they submit to SSA directly or
through a representative, claimant, or
other individual or entity. The
respondents for this collection are
medical sources that: (1) Meet one of the
exclusionary categories set forth in
section 223(d)(5)(C)(i) of the Act, as
amended; and (2) furnish evidence
related to a claim for benefits under
Titles II or XVI of the Act.
Type of Request: Revision of an OMBapproved information collection.
Regulation section(s)
Number of
respondents
Frequency of
response
Number of
responses
Average
burden per
response
(minutes)
Estimated
total annual
burden
(hours)
404.1503b(c), 416.903b(c) ...................................................
50
60
3,000
20
1,000
Dated: August 8, 2019.
Naomi Sipple,
Reports Clearance Officer, Social Security
Administration.
these determinations be published in
the Federal Register.
DEPARTMENT OF STATE
Chi
Tran, Paralegal Specialist, Office of the
Legal Adviser, U.S. Department of State
(telephone: 202–632–6471; email:
section2459@state.gov). The mailing
address is U.S. Department of State, L/
PD, SA–5, Suite 5H03, Washington, DC
20522–0505.
[Delegation of Authority No. 474]
FOR FURTHER INFORMATION CONTACT:
[FR Doc. 2019–17281 Filed 8–12–19; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice 10843]
The
foregoing determinations were made
pursuant to the authority vested in me
by the Act of October 19, 1965 (79 Stat.
985; 22 U.S.C. 2459), Executive Order
12047 of March 27, 1978, the Foreign
Affairs Reform and Restructuring Act of
1998 (112 Stat. 2681, et seq.; 22 U.S.C.
6501 note, et seq.), Delegation of
Authority No. 234 of October 1, 1999,
and Delegation of Authority No. 236–3
of August 28, 2000.
SUPPLEMENTARY INFORMATION:
Notice of Determinations; Culturally
Significant Objects Imported for
Exhibition—Determinations: ‘‘Lari
Pittman: Declaration of Independence’’
Exhibition
jspears on DSK3GMQ082PROD with NOTICES
Type of Request: Revision of an OMBapproved information collection.
SUMMARY: Notice is hereby given of the
following determinations: I hereby
determine that certain objects to be
included in the exhibition ‘‘Lari
Pittman: Declaration of Independence,’’
imported from abroad for temporary
exhibition within the United States, are
of cultural significance. The objects are
imported pursuant to a loan agreement
with the foreign owner or custodian. I
also determine that the exhibition or
display of the exhibit objects at the
Hammer Museum, Los Angeles,
California, from on or about September
29, 2019, until on or about January 5,
2020, and at possible additional
exhibitions or venues yet to be
determined, is in the national interest.
I have ordered that Public Notice of
VerDate Sep<11>2014
17:51 Aug 12, 2019
Jkt 247001
Marie Therese Porter Royce,
Assistant Secretary, Bureau of Educational
and Cultural Affairs, Department of State.
[FR Doc. 2019–17335 Filed 8–12–19; 8:45 am]
BILLING CODE 4710–05–P
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Delegation of Authority To Concur
With Decisions by the Secretary of
Energy To Enter Into Agreements
Relating to Contributions for Certain
Nonproliferation Programs
By virtue of the authority vested in
the Secretary of State, including section
1 of the State Department Basic
Authorities Act, as amended (22 U.S.C.
2651a), and to the extent authorized by
law, I hereby delegate to the Under
Secretary for Arms Control and
International Security the authority to
concur with decisions by the Secretary
of Energy to enter into agreements
relating to contributions for certain
Department of Energy nonproliferation
programs, as described in 50 U.S.C.
2569(f).
The Secretary or the Deputy Secretary
may at any time exercise any authority
or function delegated by this delegation
of authority. Any act, authority, or
procedure subject to, or affected by, this
delegation shall be deemed to be such
act, authority, or procedure as amended
from time to time.
This delegation of authority shall be
published in the Federal Register.
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]]>Agencies
[Federal Register Volume 84, Number 156 (Tuesday, August 13, 2019)]
[Notices]
[Pages 40121-40124]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-17281]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Docket No: SSA-2019-0034]
Agency Information Collection Activities: Proposed Request and
Comment Request
The Social Security Administration (SSA) publishes a list of
information collection packages requiring clearance by the Office of
Management and Budget (OMB) in compliance with Public Law 104-13, the
Paperwork Reduction Act of 1995, effective October 1, 1995. This notice
includes one new, one extension, and revisions of OMB-approved
information collections.
SSA is soliciting comments on the accuracy of the agency's burden
estimate; the need for the information; its practical utility; ways to
enhance its quality, utility, and clarity; and ways to minimize burden
on respondents, including the use of automated collection techniques or
other forms of information technology. Mail, email, or fax your
comments and recommendations on the information collection(s) to the
OMB Desk Officer and SSA Reports Clearance Officer at the following
addresses or fax numbers.
(OMB) Office of Management and Budget, Attn: Desk Officer for SSA, Fax:
202-395-6974, Email address: [email protected].
(SSA) Social Security Administration, OLCA, Attn: Reports Clearance
Director, 3100 West High Rise, 6401 Security Blvd., Baltimore, MD
21235, Fax: 410-966-2830, Email address: [email protected].
Or you may submit your comments online through www.regulations.gov,
referencing Docket ID Number [SSA-2019-0034].
I. The information collection below is pending at SSA. SSA will
submit it to OMB within 60 days from the date of this notice. To be
sure we consider your comments, we must receive them no later than
October 15, 2019. Individuals can obtain copies of the collection
instruments by writing to the above email address.
Advance Representative Payee Representative Payee Supporting
Statement for Advance Designation of Representative Payee--0960-NEW. On
April 13, 2018, the President signed into law The Strengthening
Protections for Social Security Beneficiaries Act of 2018, also known
as Public Law 115-165. Section 201 of the law allows SSA beneficiaries
and applicants under Title II, Title VIII and Title XVI, of the Social
Secuirty Act (Act) to designate individuals to serve as a
representative payee should the need arise in the future. Section
201(j)(2) of the Act provides the requirements for selecting a
qualified representative payee. SSA only offers the option to advance
designate to capable adults and emancipated minors. Beneficiaries who
have an assigned representative payee, or have a representative
application in process, cannot advance designate. Form SSA-4547,
Advance Designation of Representative Payee, allows beneficiaries or
applicants the option to designate individuals in order of priority, to
serve as a representative. Beneficiaries or applicants can update or
change the advance designee order of priority at any time. SSA uses the
information on Form SSA-4547 to select a qualified representative payee
in order of priority. If the selected representative payee is unable or
unwilling to serve, or meet SSA requirements, SSA will select another
representative payee to serve in the beneficiaries and applicants best
interest. SSA will notify beneficiaries annually of the individuals
they chose in advance to be their representative payee. The respondents
are SSA beneficiaries and claimants who want to choose an advance
designate representative.
Type of Request: Request for a new information collection.
----------------------------------------------------------------------------------------------------------------
Total
Number of Frequency of Average burden estimated
Modality of completion responses response per response total annual
(minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-4547--Paper Version......................... 85,733 1 6 8,573
SSA-4547--Intranet version (SSI Claims System; 8,451,966 1 6 845,197
MCS; iMAIN)....................................
i4547--Internet version......................... 3,201,466 1 6 320,147
---------------------------------------------------------------
Totals...................................... 11,739,165 .............. .............. 1,173,917
----------------------------------------------------------------------------------------------------------------
II. SSA submitted the information collections below to OMB for
clearance. Your comments regarding these information collections would
be most useful if OMB and SSA receive them 30 days from the date of
this publication. To be sure we consider your comments, we must receive
them no later than September 12, 2019. Individuals can obtain copies of
the OMB clearance packages by writing to [email protected].
1. Report to United States Social Security Administration by Person
Receiving Benefits for a Child or for an Adult Unable to Handle Funds/
Report to the United States Social Security Administration--0960-0049.
Section 203(c) of the Act requires the Commissioner of SSA to make
benefit deductions, and provides for the Commissioner to impose penalty
deductions on benefits of individuals who fail to make timely reports
of events, which are cause for deductions. SSA uses Forms SSA-7161-OCR-
SM and SSA-7162-OCR-SM to: (1) Determine continuing entitlement to
Social Security benefits; (2) correct benefit amounts for beneficiaries
outside the United States; and (3) monitor the performance of
representative payees outside the United States. This collection is
mandatory as an annual (or every other year, depending on the country
of residence) review for fraud prevention. In addition, the results can
affect benefits by increasing or decreasing payment amount or by
causing SSA to suspend or terminate benefits. The respondents are
individuals living outside the United States who are receiving benefits
on their own (or on behalf of someone else) under Title II of the Act.
Type of Request: Revision of an OMB-approved information
collection.
[[Page 40122]]
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7161-OCR-SM................................. 42,314 1 15 10,579
SSA-7162-OCR-SM................................. 426,448 1 5 35,537
---------------------------------------------------------------
Totals...................................... 468,762 .............. .............. 46,116
----------------------------------------------------------------------------------------------------------------
2. Waiver of Your Right to Personal Appearance before an
Administrative Law Judge--20 CFR 404.948(b)(l)(i) and
416.1448(b)(l)(i)--0960-0284. Applicants for Social Security, Old Age,
Survivors and Disability Insurance (OASDI) benefits and Supplemental
Security Income (SSI) payments have the statutory right to appear in
person, or through a representative, and present evidence about their
claims at a hearing before an administrative law judge (ALJ). If
claimants wish to waive this right to appear before an ALJ, they must
do so in writing. Form HA-4608 serves as a written waiver for the
claimant's right to a personal appearance before an ALJ. The ALJ uses
the information we collect on Form HA-4608 to continue processing the
case, and makes the completed form a part of the documentary evidence
of record by placing it in the official record of the proceedings as an
exhibit. Respondents are applicants or claimants for OASDI and SSI, or
their representatives, who request to waive their right to appear in
person before an ALJ.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
HA-4608..................................... 12,000 1 2 400
----------------------------------------------------------------------------------------------------------------
3. Request for Social Security Statement--20 CFR 404.810--0960-
0466. Section 205(c)(2)(A) of the Act requires the Commissioner of SSA
to establish and maintain records of wages paid to, and amounts of
self-employment income derived by, each individual as well as the
periods in which such wages were paid and such income derived. An
individual may complete and mail Form SSA-7004 to SSA to obtain a
Statement of Earnings or Quarters of Coverage. SSA uses the information
Form SSA-7004 collects to identify respondent's Social Security
earnings records; extract posted earnings information; calculate
potential benefit estimates; produce the resulting Social Security
statements; and mail them to the requesters. The respondents are Social
Security number holders requesting information about their Social
Security earnings records and estimates of their potential benefits.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-7004.................................... 60,026 1 5 5,002
----------------------------------------------------------------------------------------------------------------
4. Function Report--Child (Birth to 1st Birthday, Age 1 to 3rd
Birthday, Age 3 to 6th Birthday, Age 6 to 12th Birthday, Age 12 to 18th
Birthday)--20 CFR 416.912 and 416.924a(a)(2)--0960-0542. As part of
SSA's disability determination process, we use Forms SSA-3375-BK
through SSA-3379-BK to request information from a child's parent or
guardian for children applying for SSI. The five different versions of
the form contain questions about the child's day-to-day functioning
appropriate to a particular age group; thus, respondents use only one
version of the form for each child. The adjudicative team (disability
examiners and medical or psychological consultants) of State disability
determination services offices collect the information on the
appropriate version of this form (in conjunction with medical and other
evidence) to form a complete picture of the children's ability to
function and their impairment-related limitations. The adjudicative
team uses the completed profile to determine: (1) If each child's
impairment(s) results in marked and severe functional limitations; and
(2) whether each child is disabled. The respondents are parents and
guardians of child applicants for SSI.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Modality of completion Number of Frequency of per response annual burden
respondents response (minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-3375; SSA[dash]3376; SSA[dash]3377; 579,000 1 20 193,000
SSA[dash]3378; SSA-3379....................
----------------------------------------------------------------------------------------------------------------
5. Private Printing and Modification of Prescribed Application and
Other Forms--20 CFR 422.527--0960-0663. 20 CFR 422.527 of the Code of
Federal Regulations requires a person, institution, or organization
(third-party
[[Page 40123]]
entities) to obtain approval from SSA prior to reproducing,
duplicating, or privately printing any application or other form the
agency owns. To obtain SSA's approval, entities must make their
requests in writing using their company letterhead, providing the
required information set forth in the regulation. SSA uses the
information to: (1) Ensure requests comply with the law and
regulations, and (2) process requests from third-party entities who
want to reproduce, duplicate, or privately print any SSA application or
other SSA form. SSA employees review the requests and provide approval
via email or mail to the third-party entities. The respondents are
third-party entities who submit a request to SSA to reproduce,
duplicate, or privately print an SSA-owned form.
This is a correction notice. SSA published this information
collection as a revision on June 4, 2019 at 84 FR 25891. Since we are
not making any revisions to this collection, this is now an extension
of an OMB-approved information collection.
Type of Request: Extension of an OMB-approved information
collection.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Average burden Estimated total
Regulation section Number of Frequency of Number of per response annual burden
respondents response responses (minutes) (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
20 CFR 422.527..................................................... 10 15 150 10 25
--------------------------------------------------------------------------------------------------------------------------------------------------------
6. Letter to Custodian of Birth Records/Letter to Custodian of
School Records--20 CFR 404.704, 404.716, 416.802, and 422.107--0960-
0693. When individuals need help in obtaining evidence of their age in
connection with Social Security number (SSN) card applications and
claims for benefits, SSA can prepare the SSA-L106, Letter to Custodian
of School Records, or SSA-L706, Letter to Custodian of Birth Records.
SSA uses the SSA-L706 to determine the existence of primary evidence of
age for SSN applicants. SSA uses both letters to verify with the
issuing entity, when necessary, the authenticity of the record
submitted by the SSN applicant or claimant. The respondents are
schools, State and local bureaus of vital statistics, and religious
entities.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-L106--Private Sector........................ 18 1 10 3
SSA-L106--State/Local/Tribal Government......... 14 1 10 2
SSA-L706--Private Sector........................ 429 1 10 72
SSA-L706--State/Local/Tribal Government......... 426 1 10 71
---------------------------------------------------------------
Totals...................................... 887 .............. .............. 148
----------------------------------------------------------------------------------------------------------------
7. Application Status--20 CFR 401.45--0960-0763. Application Status
provides users with the capability to check the status of their pending
Social Security claims via the National 800 Number Automated Telephone
Service. Users need their SSN and a confirmation number to access this
information. SSA systems determine the type of claim(s) the caller
filed based upon the information provided. Subsequently, the automated
telephone system provides callers with the option to choose the claim
for which they wish to obtain status. If the caller applied for
multiple claims, the automated system allows the caller to select only
one claim at a time. Once callers select the claim(s) they are calling
about, an automated voice advises them of the status of their claim.
The respondents are current Social Security claimants who wish to check
on the status of their claims.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average burden Estimated
Modality of completion Number of Frequency of per response total annual
respondents response (minutes) burden (hours)
----------------------------------------------------------------------------------------------------------------
Application Status--Automated Telephone 248,485 1 3 12,424
System.....................................
----------------------------------------------------------------------------------------------------------------
8. Government-to-Government Services Online Website Registration
Form; Government-to-Government Services Online Website Account
Modification/Deletion Form--20 CFR 401.45--0960-0757. The Government-
to-Government Services Online (GSO) website allows various external
organizations to submit files to a variety of SSA systems and, in some
cases, receive files in return. The SSA systems that process data
transferred via GSO include, but are not limited to, systems
responsible for disability processing and benefit determination or
termination. SSA uses the information on Form SSA-159, Government-to-
Government Online website Registration Form, to register the requestor
to use the GSO website. Once we receive the SSA-159, SSA provides the
user with account information and conducts a walkthrough of the GSO
website as necessary. Established organizations may submit Form SSA-159
to register additional users as well. The established requesting
organizations can also complete Form SSA-160, Government-to-Government
Online website Account Modification/Deletion Form, to modify
[[Page 40124]]
their online accounts (e.g., address change). Respondents are State and
local government agencies, and some private sector business entities.
Type of Request: Revision of an OMB-approved information
collection.
----------------------------------------------------------------------------------------------------------------
Average Estimated
Number of Frequency of burden per total annual
Modality of completion respondents response response burden
(minutes) (hours)
----------------------------------------------------------------------------------------------------------------
SSA-159......................................... 1,151 1 15 288
SSA-160......................................... 410 1 15 103
---------------------------------------------------------------
Totals...................................... 1,561 .............. .............. 391
----------------------------------------------------------------------------------------------------------------
9. Evidence From Excluded Medical Sources of Evidence--20 CFR
404.1503b and 416.903b--0960-0803. Pursuant to its broad authority to
regulate under sections 205(a), 702(a)(5), and 1631(d)(1) of the Act,
SSA implemented section 223(d)(5)(C), as amended, through regulations
at 20 CFR 404.1503b and 416.903b. These regulations require excluded
medical sources to self-report their excluded status in writing each
time they submit evidence related to a claim for benefits under Titles
II or XVI of the Act. Excluded medical sources' duty to self-report
their excluded status apply to evidence they submit to SSA directly or
through a representative, claimant, or other individual or entity. The
respondents for this collection are medical sources that: (1) Meet one
of the exclusionary categories set forth in section 223(d)(5)(C)(i) of
the Act, as amended; and (2) furnish evidence related to a claim for
benefits under Titles II or XVI of the Act.
Type of Request: Revision of an OMB-approved information
collection.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Average burden Estimated
Regulation section(s) Number of Frequency of Number of per response total annual
respondents response responses (minutes) burden (hours)
--------------------------------------------------------------------------------------------------------------------------------------------------------
404.1503b(c), 416.903b(c).......................................... 50 60 3,000 20 1,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Dated: August 8, 2019.
Naomi Sipple,
Reports Clearance Officer, Social Security Administration.
[FR Doc. 2019-17281 Filed 8-12-19; 8:45 am]
BILLING CODE 4191-02-P
